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Postdischarge Bleeding After Percutaneous Coronary Intervention and Subsequent Mortality and Myocardial Infarction:
Javier A Valle1, Susan Shetterly2, Thomas M Maddox2
1From the Division of Cardiology, University of Colorado, Aurora (J.A.V, T.M.M., P.M.H., S.M.B., A.S., T.T.T.); The Institute For Health Research, Kaiser Permanente Colorado, Denver (S.S., D.M., T.T.T.); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H., S.M.B.); and The Colorado Cardiovascular Outcomes Research Consortium, Denver (J.A.V., T.M.M., P.M.H., S.M.B., A.S., D.M., T.T.T.). javier.valle@ucdenver.edu.
Insights
Bleeding after percutaneous coronary intervention (PCI) hospitalization increases risks for heart attack and death. Patients experiencing bleeding are most vulnerable in the 60 days following the bleeding event.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Bleeding after percutaneous coronary intervention (PCI) discharge is linked to higher risks of myocardial infarction (MI) and death.
- The precise timing of these adverse events following bleeding is not well understood.
- Identifying critical risk periods can aid clinical management.
Purpose of the Study:
- To define the rates and timing of postdischarge bleeding events.
- To assess the association between postdischarge bleeding and subsequent MI or death.
- To identify critical time windows for increased patient risk.
Main Methods:
- Utilized the HMO Research Network-Stent (HMORN-Stent) Registry (2004-2007).
- Included patients surviving PCI discharge without in-hospital bleeding.
- Employed Cox proportional hazards models to analyze associations between bleeding and adverse outcomes.
Main Results:
- Of 8137 patients, 391 (4.8%) experienced postdischarge bleeding.
- The highest incidence of bleeding occurred within 30 days of discharge.
- Postdischarge bleeding significantly increased the risk of death or MI (HR 3.09).
- The risk of death or MI was highest within 60 days post-bleeding (HR 7.16).
Conclusions:
- About 5% of post-PCI patients are readmitted for bleeding, predominantly within 30 days.
- Postdischarge bleeding elevates the risk of subsequent death or MI.
- A critical 60-day window exists post-bleeding for heightened patient vulnerability.
Background:
Bleeding after hospital discharge from percutaneous coronary intervention (PCI) is associated with increased risk of subsequent myocardial infarction (MI) and death; however, the timing of adverse events after these bleeding events is poorly understood. Defining this relationship may help clinicians identify critical periods when patients are at highest risk.
Methods And Results:
All patients undergoing PCI from 2004 to 2007 who survived to hospital discharge without a bleeding event were identified from the HMO Research Network-Stent (HMORN-Stent) Registry. Postdischarge rates and timing of bleeding-related hospitalizations, MI, and death were defined. We then assessed the association between postdischarge bleeding-related hospitalizations with death and MI using Cox proportional hazards models. Among 8137 post-PCI patients surviving to hospital discharge without in-hospital bleeding, 391 (4.8%) had bleeding-related hospitalization after discharge, with the highest incidence of bleeding-related hospitalizations occurring within 30 days of discharge (n=79, 20.2%). Postdischarge bleeding-related hospitalization after PCI was associated with subsequent death or MI (hazard ratio, 3.09; 95% confidence interval, 2.41-3.96), with the highest risk for death or MI occurring in the first 60 days after bleeding-related hospitalization (hazard ratio, 7.16; confidence interval, 3.93-13.05).
Conclusions:
Approximately 1 in 20 post-PCI patients are readmitted for bleeding, with the highest incidence occurring within 30 days of discharge. Patients having postdischarge bleeding are at increased risk for subsequent death or MI, with the highest risk occurring within the first 60 days after a bleeding-related hospitalization. These findings suggest a critical period after bleeding events when patients are most vulnerable for further adverse events.